Effects of Pain Interference in Children With Chronic Pain

Child with headache
Child with headache
Pain interference was found to mediate the relationship between pain and depression in children with chronic pain.

An analysis of self-reports and medical and psychological assessments in children with chronic pain revealed high levels of depression, school absence, and pain interference.1 In addition, pain interference was found to mediate the relationship between pain and depression. Results of the study by Rikard K. Wicksell, PhD, of the Karolinska University Hospital, Stockholm, Sweden, and colleagues were published online in Frontiers of Psychology.

The study aimed to determine the differences in demographic variables, pain, and pain interference in pediatric patients with chronic pain; and explore how pain interference mediates the relationship between pain and functioning.

The investigators recruited 163 patients and their parents who had been referred to a tertiary pain clinic due to long-standing and/or recurrent pain. Participants received medical and psychological assessments in order to characterize their pain by intensity, location, and onset/duration, and to determine the impact of pain on their emotional, social, and physical functioning.

Standardized instruments used in the study were the Center for Epidemiological Studies-Depression Scale for Children (CES-DC), which measures symptoms of depression during the previous week2; the Functional Disability Inventory-Parent version (FDI-P), which measures functioning in everyday activities3; and the Pain Interference Index (PII), which measures pain-related interference in everyday life.4

Results showed significantly more depression in girls compared with boys, higher levels of depression and pain interference in children with severe disability compared with children with absent to moderate disability, and higher FDI-P and PII scores in children whose CES-DC scores indicated major depression. No significant differences were found between children with pain in multiple vs single locations. In addition, the researchers found significant indirect effects of pain interference on the relationship between pain intensity and depression (P <.01).

Summary and Clinical Applicability

“This study adds to the growing support of findings suggesting that functioning and pain interference should be routinely assessed in pediatric chronic pain and a central target in treatment,” wrote the investigators in their conclusion. “Particularly, these findings imply a need for interventions specifically aimed at improved functioning for patients with chronic debilitating pain.”


The investigators noted several potential limitations of their study, including:

  • The possibility that the cohort of patients recruited from a tertiary pain clinic was not representative of the larger population of children with chronic pain
  • Inherent limitations in the use of cross-sectional data
  • A lack of objective measures of functioning
  • A lack of data on pain management in study patients

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  1. Wicksell RK, Kanstrup M, Kemani MK, Holmström L. Pain interference mediates the relationship between pain and functioning in pediatric chronic pain. Front Psychol. 2016;7:1978. doi:10.3389/fpsyg.2016.01978
  2. Garrison CZ, Addy CL, Jackson KL, Mckeown RE, Waller JL. The CES-D as a screen for depression and other psychiatric disorders in adolescents. J Am Acad Child Adolesc Psychiatry. 1991;30(4):636-641.
  3. Claar RL, Walker LS. Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory. Pain. 2006;121(1-2):77-84.
  4. Holmström L, Kemani MK, Kanstrup M, Wicksell RK. Evaluating the statistical properties of the pain interference index in children and adolescents with chronic pain. J Dev Behav Pediatr. 2015;36(6):450-454.